Degenerative Disc Disease: 7 Proven Ways for Lasting Relief

Diagnosing Degenerative Disc Disease: Facing the 800-Pound Gorilla

Accurately diagnosing Degenerative Disc Disease (DDD) is both an art and a science. It requires a thoughtful combination of detailed medical history, comprehensive physical examination, and advanced imaging techniques like MRI or CT scans. But here’s the challenge — while imaging can reveal disc degeneration, these findings are often present in people who have no back pain at all.

This disconnect between what we see on scans and what patients feel makes diagnosing discogenic pain far more complex than simply pointing to a degenerated disc on an MRI. In certain nuanced cases, tools like provocative discography have been used in an attempt to pinpoint the exact source of pain, particularly when multiple degenerated discs are visible. However, even these approaches come with controversy and limitations.

We could easily turn this discussion into an entire textbook chapter — but it’s impossible to ignore the central question every patient and clinician faces when dealing with chronic back pain:

“How do we truly determine if your back pain is coming from Degenerative Disc Disease?”

Understanding Discogenic Pain

Discogenic pain refers to discomfort originating directly from a damaged or degenerated spinal disc. The most common symptoms include:

• Persistent low back pain centered along the spine
• Worsening pain when sitting, bending, or lifting
• Relief when standing or lying flat
• Pain that stays above the knees (unlike sciatica)

Discogenic vs. Vertebrogenic Pain

Both cause chronic back pain, but their sources differ:

• Discogenic Pain: Arises from the disc itself due to internal disruption or annular tears.
• Vertebrogenic Pain: Linked to inflammation at the vertebral endplates, often associated with Modic changes seen on MRI scans.

The Role and Limits of Imaging Studies

While MRIs are excellent at showing disc degeneration, studies reveal that these changes are common even in people without pain. A major review found that up to 80% of adults over 50 show signs of disc degeneration despite having no symptoms (Brinjikji et al., 2015).

This is why relying solely on imaging can be misleading — diagnosing DDD-related pain requires more than just looking at scans.

The Rise and Fall of Provocative Discography

In an effort to identify painful discs, doctors developed provocative discography, a procedure where contrast dye is injected into discs to see if it reproduces the patient’s pain. While useful in theory, it became controversial due to:

• High rates of false positives
• Risk of accelerating disc degeneration
• Inconsistent predictive value for surgical outcomes (NIH Review)

Today, discography is rarely used and only considered in highly selective cases.

Modern Approach to Diagnosing DDD

Experienced interventional spine specialists, like Dr. Amit Sharma, use a comprehensive approach:

• Detailed symptom history and pain patterns
• Focused physical examination
• Correlation with imaging — but not over-reliance
• Occasionally, diagnostic nerve blocks to rule out other causes

Self-Assessment: Are You Likely Suffering from Discogenic Pain?

While only a doctor can diagnose you, here’s a simple awareness checklist. Our team lovingly calls it “The SpinePain Criteria”.

• ✅ Central low back pain (+1)
• ✅ Pain worsens when sitting (+1)
• ✅ Pain improves when lying down (+1)
• ✅ No significant leg pain or numbness (+1)
• ✅ Pain increases with bending or twisting (+1)

Score:

• 0-2 Points: Unlikely discogenic pain
• 3-4 Points: Possible disc-related pain — consider evaluation
• 5 Points: Likely discogenic pain — consult a spine specialist

This is not a diagnostic tool. Always seek medical advice for persistent back pain.

To get a definitive diagnosis and rule out other causes like facet joint pain, sacroiliac dysfunction, or vertebrogenic pain, consult Dr. Sharma, an expert in interventional spine care.

Intradiscal Regenerative Medicine Options for Degenerative Disc Disease

Emerging regenerative therapies offer promising alternatives to traditional treatments for Degenerative Disc Disease (DDD). Below is a comparison of three notable intradiscal regenerative options.

1. Platelet-Rich Plasma (PRP)

Overview: PRP involves concentrating a patient’s own platelets and injecting them into the degenerated disc to promote healing.

Evidence: A study demonstrated significant pain relief and improved lumbar function over a 48-week period following intradiscal PRP injections. [Study Link]

2. Bone Marrow Concentrate (BMC)

Overview: BMC is derived from the patient’s own bone marrow and contains stem cells and growth factors that may aid in disc regeneration.

Evidence: Research indicates that intradiscal BMC injections can lead to significant improvements in pain and disability scores, with sustained benefits observed over a three-year follow-up. [Study Link]

3. Wharton’s Jelly Mesenchymal Stem Cells (WJ-MSCs)

Overview: WJ-MSCs are derived from the gelatinous substance within the umbilical cord and have shown potential in regenerating degenerated discs.

Evidence: Studies suggest that WJ-MSC transplantation can maintain disc height and promote matrix formation, indicating their value in treating DDD. [Study Link]

Comparison Summary

FDA Disclaimer: The regenerative therapies discussed are considered investigational and are not yet approved by the U.S. Food and Drug Administration (FDA) for the treatment of Degenerative Disc Disease. Patients should consult with their healthcare providers to understand the potential risks and benefits.

Is Spinal Fusion a Permanent Solution for Degenerative Disc Disease?

Spinal fusion is often considered when severe Degenerative Disc Disease (DDD) leads to chronic pain unresponsive to other treatments. While fusion can reduce pain by eliminating motion at the degenerated segment, it is important to understand that it does not reverse disc degeneration or “cure” DDD.

Does It Get Better Forever?

For some patients, spinal fusion provides long-term pain relief. However, fusion alters spinal mechanics, often leading to a condition known as Adjacent Segment Disease (ASD), where discs above or below the fused segment begin to degenerate due to increased stress. Therefore, while spinal fusion may improve symptoms at one level, it can predispose patients to future spine problems. It is not typically considered a “permanent fix” for the spine overall.

The United States and Spinal Fusion Rates

The U.S. performs the highest number of spinal fusion surgeries worldwide. Studies show that spinal fusion rates in the U.S. have increased by over 300% in recent decades [Spine Journal]. Compared to countries like Sweden, the UK, or Canada—where stricter surgical criteria are applied—the U.S. healthcare system sees more frequent use of fusion, sometimes raising concerns about overuse.